| Case Details | |
| Court / Division* | [select court/division] |
| Title of Proceedings | |
| [First] Claimant/Appellant* | [full name] |
| Filing Details | |
| Filed for* | [name], [role of party, e.g. claimant] |
| Change of Representation |
| [name], [role of party], has appointed [name of lawyer], [firm], to act as the [role of party]'s lawyer in these proceedings (in the place of [name of former lawyer], [firm] (delete if change is from self-representation)). |
| Signature* (complete as applicable) | |
| Signature of party | __________________________________________ |